1083000160 NPI number — KYUNGSOOK YOON AGPCNP-BC, APNP

Table of content: KYUNGSOOK YOON AGPCNP-BC, APNP (NPI 1083000160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083000160 NPI number — KYUNGSOOK YOON AGPCNP-BC, APNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOON
Provider First Name:
KYUNGSOOK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AGPCNP-BC, APNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083000160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6400 INDUSTRIAL LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENDALE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53129-2452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-423-4100
Provider Business Mailing Address Fax Number:
414-423-4134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7733 W BURLEIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53222-5003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-837-6300
Provider Business Practice Location Address Fax Number:
414-763-3602
Provider Enumeration Date:
04/15/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  6273-33 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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